The Book Review, Sunday, April 1, 2012: Meaning, Medicine and the 'Placebo Effect'

Have you ever had such an incredible headache that aspirin couldn't touch it but then someone suggested going to the movie and even though you didn't feel like it you went and once you got into the movie you felt no pain and then when the movie was over you suddenly realized you hadn't been in pain but as soon as you realized that the pain came back?

That's not an example of the placebo effect, but it does show just how much the pain we feel can be influenced by what's going on around us.

In "Meaning, Medicine and the 'Placebo Effect,'" by Daniel Moerman, we get insight into something even more difficult to understand: the fact that illnesses can be "cured" as well as pain relieved by chemically inert medical treatments. In fact, just being seen by a kind and caring medical professional, and especially receiving a diagnosis, can "cure" a person in many cases.

Here are just a few of the factors involved:

---Culture of origin:  If you believe that being born under certain astrological signs makes you unlucky or likely to die from a certain disease, the chances that you will die from that disease are much greater than for someone who does not share that belief.

---Country of origin: If you're American, you may think that getting a shot will help you get well better than taking a pill will, and you'll probably be right.

---Disease or diagnosis: Conditions ranging from lumbar disk herniation to Meniere's disease have been "cured" equally well by real surgery and "negative operations." But if you have a headache, taking a "placebo" pill will not be as helpful as taking a real aspirin (though going to a movie may help!).

---The patient's own life experiences and cultural background: This is huge, ranging from whether you're an optimist or not (patients who rated their own health as "excellent" had better than twice as good a chance of being still alive after several years as those who rated their health as "poor").

---The patient's confidence in the doctor or surgeon's ability and success: Some patients who received nothing more than three pin-pricks in their knees instead of actual arthroscopic surgery were "cured" and remained pain free for years afterwards; the same kind of results were repeated for many kinds of surgeries and treatments.

---The kind and color of the pill or capsule and the amount prescribed: Why do you think Viagra pills are blue?  Why do you think if two sugar pills make your headache go away, then four sugar pills make it go away even faster? Aha! There's something to this...

Moerman writes in his "Acknowledgments" section, "I have had great fun with this project; I kept telling myself how easy it would be to write a 'placebo book' because it doesn't have anything in it." He isn't just discussing placebos, though. He's discussing meaning in medicine, putting together his own many years of research as a medical anthropologist with research done by other anthropologists and medical professionals over decades.

With all this in mind, what would Moerman do if he were told he needed coronary artery bypass surgery, for instance? He writes:

"As with any serious and dangerous procedure, I'd first seek a second opinion. If the second opinion were the same as the first, I would go ahead with the procedure. I would want an enthusiastic and very experienced surgeon (I know just the guy), and I would ask him to be as non-invasive as possible....I would ask that they play Louis Armstrong recordings during the operation--loudly!--and that I be able to listen to Stan Getz and Joao Gilberto in the recovery room.

"And, when I have a headache, or some aches or pains in my back or leg, I shake two ibuprofen tablets into my hand, I look at them carefully, and I say, 'Guys, you are the best, the most powerful and trouble-free drugs in the world.' Or something like that. Then, with a large glass of water ('Water is good, too,' I think carefully to myself), down the hatch.

"You know what I mean."

And there you have it. Madame L highly recommends this book. You don't have to be a doctor or an anthropologist to enjoy it. You should, however, be willing to give up some of your carefully cherished beliefs about medicine and healing, about placebos and their place in medicine and healing, and about yourself.